Loading...
HomeMy WebLinkAboutBuilding Permit #294-11 - 250 JOHNSON STREET 10/12/2010 BUILDING PERMIT Of No oT b A1ti TOWN OF NORTH ANDOVER h ''' • o O APPLICATION FOR PLAN EXAMINATION T H Permit NO: l �.I Date Received r SSACHUS� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION � •2'e� �/ Print PROPERTY.OWNER.:..l!t 4-4 I?rint i MAP.210 PARCEL ZONING DISTRICT: Historic Dis'tric't' ye .. Machine Shop.Village y.. n TYPE OF IMPROVEMENT PROPOSED USE E Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `Septic Well D Floodplain ` UVetlarids 0::Watershed District. ❑Water/Sewer. DESCRIPTION OF WORK TO BE PERFORMED: lea. (41- a Identification Please Type or Print Clearly) OWNER: Name: ` f9 I C 4 Phone: Address: CONTRACTOR Names'`K. "'� �hone: l /✓ Address:. Supervisor's.Construction License: Exp:'Date:: H6mr o..lmprovement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEESCHEDULE:BULDING PERMIT;$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ QOoo FEE: $ 141.-- ,3 'a Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,and Signature of Agent/Own Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments `Conservation Decision: Comments Water & Sewer Connection/Sic nature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Msiri Street Fire De part merit si nature/date P 9 COMMENTS. Dimension Number of Stories:_________Totalsquare feet of floor area, based on Exterior dimensions. � Total land area, sq. ft.: r location, mast or service drop requires approval of ELECTRICAL: Movement of Mete Electrical Inspector Yes No DANGER ZONE I ITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use I I i I ® Notified for pickup - Date Doc.Building Permit Revised 2010/October Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers -Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) I ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered®TE: All dumpsterroducts - p permits require sign off from Fire Department prior to issuance of Bldg Permit ]En all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Must be submitted with the building application Doe:Building Permit Revised 2008 No. Date �! NORTq TOWN OF NORTH ANDOVER 3 OL 9 ♦ i Certificate of Occupancy $ �<� Building/Frame/Frame Permit Fee $ s.KMus E 9 Foundation Permit Fee $ Other Permit Fee $ F TOTAL $ Check # 3, —(toe 2 3 5 6Building Inspector NORTH Tolm Of 0 No. (`O LAK -0 dover, Mass., 16 . COC MICKEWICK ADRATED p, �� `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ... ......, .......0 r 7.�,� �..���� Foundation has permission to erect........................................ buildings on ..!;..-� ....... ....KI... . ....3 ...A.................... Rough to be occupied as....... ... 'r ................... a Chimney ........ .. ..... ........ .................................................................... provided that the person ac opting this permit shall in a respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough _ Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS NST TS Rough ................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the- Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. of µoRTH TOWN OF NORTH ANDOVER eo 'S 020 OFFICE OF BUILDING DEPARTMENT *� 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 SACHUS� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: V/—/Z JOB LOCATION: Number Street Address Map/Lot IJOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Tom CtMt� ?ip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. , HOMEOWNERS SIGNAT r- \ APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 �'� 5�• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): y' Address: ,�. -3r— Are Z�,f City/State/Zip: � Phone#: ����' ��� Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. F1 Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.E]Electrical repairs or additions required.] o 3. 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. LN o workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs Y p insurance required.] employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi y un der•the pWinenalfles ofperlury that the information provided a ove is true and correct. Si ature: Date: �� �2 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TRANSMISSION VERIFICATION REPORT TIME 86/8612807 16:30 NAME HEALTH FAX 9786888476 TEL : 9786888476 SER.# 000E4J120960 DATE,TIME 06/06 16: 30 FAX NO.INAME 89786855900 DURATION 00:00: 27 PAGE{S) 03 RESULT OK MODE STANDARD ECM North Andover Health D_op irtment 1600 Osgood Street Building 20, Suite 2-36 Letter of Transmittal w North Andover, MA 01845 10 } n 978.688.9540 - Phone Pae of 7 �Atoo ►�'y g s 978.688.8476 fax s,, a CHU henithd pl a,toME Orth n ave 4com- E-mail w_w_w.to_wnofnorthandover.cam,Website TO. DATE: COMPANY: FROM: Pamela QelleChiaie,Health department Assistant Phone, X - r Fox; WO are$ending you. L7+COPY Of Letter L7 f/q S L7 Other jfill in hole ry . 1 These are transmitted as checked below: > Dfor4 rvw > 17&%&o G7AsRMwsW ➢ L71bwA wvdmwmw g REMARKS: COPY TO: North Andover Health Department NORTFt 1600 Osgood Street Letter of Transmittal 3� ```'' ° ° Building 20, Suite 2-36 North Andover, MA 01845 - 978.688.9540 - Phone c .4 Page I of �► °'V.Te° 978.688.8476 — Fax �sSHus�� healthdeRt(CD-townofnorthandover com-E-mail www.townofnorthandover.com-Website T0: DATE: COMPANY: FROM: Pamela DelleChiaie,Health Department Assistant Phone: �`� c� 66 - RE: Fax: / We ore sending you: O Copy of Letter O Plans O Other I(fi//in below) These are transmitted as checked below: ➢ L74Pvwdiz bfhd ➢ Dr r4qo "i ➢ Dam6n* apfesfar ➢ OAvAbgm*d ➢ afiorlit-4wxdxnxw t DAs/Pegc ad ➢ Mrrow& ➢ L7&Ak t qpiesf8r&t- REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: BOARD OF HEALTH TOWN OF NORTH ANDOVER REGULATIONS FOR SEWER TIE-IN 1. 0 Authoritv Under the authority of Chapter 111, Section 31 and Chapter 83 , Section 11 of the Massachusetts General Laws, the Board of Health of the Town of North Andover adopted the following regulations at a public meeting held on March 17, 1994 . 2. 0 Purpose The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwaters and surrounding environment by requiring all residents to hook up to municipal sewer whenever possible. Sanitary sewer is believed to be the most effective form of wastewater treatment. 3 . 0 Definitions Establishment: Includes but not limited to all schools, nursing homes, camps, single and multiple dwelling units, country clubs, churches, mobile homes, office buildings, restaurants, service stations, retail stores Individual septic system: Any subsurface sewage disposal system, including cesspools, consisting of household wastewater, including graywater, owned and operated by a person as defined below. Owner: Every person who alone, or jointly, or severally with others has legal title to any dwelling or dwelling unit or has care, charge, or control of any dwelling or dwelling unit as agent, executor, executrix, administrator, administratrix, trustee, lessee, or guardian of the estate of the holder of legal title. Person: Every individual, partnership, corporation, firm, association, or group owning property. Sewer: A pipe which carries sewage without storm, surface or ground waters. Watershed: The land area in North Andover which delineates all surface and groundwater which drains to Lake Cochichewick. 4 . 0 Terms of Connection / 4. 1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a maximum time limit of six months. 4 . 2 All establishments outside the North Andover watershed that are currently able to connect with the municipal sewer have a maximum of two (2) years from March 17, 1994 to tie-in. 4 . 3 All residences inside the Lake Cochichewick watershed that are currently able to to connect with the municipal sewer have a maximum of one year from March 17, 1994 to tie-in. 5. 0 Variances 5. 1 The Board of Health may vary the application of the time frame during which any individual connection must be made to the municipal sewer. 5. 2 Variances will be based on significant financial hardship only. A properly functioning septic system will not be considered a factor for a variance. 5. 3 Every request for a variance shall be made in writing and submitted with documentary proof of the specific financial hardship. 6. 0 Penalties 6. 1 Any person or owner who shall fail to comply with this regulation shall be punished by a fine not more than two hundred ($200. 00) dollars and legal action. 7. 0 Severability If any provision, sentence,, clause or phrase of this regulation is held to be unconstitutional, or in violation of state law, the remainder of the regulation shall continue in full force.